Q@Q time ⑨ - cardio69

[ArchivalUser]

D Left medial medullary syndrome

[ArchivalUser]

*D* correct.
Sorry for late reply Ana Lets review you it bz from ans other Qs & as ppl couldn't ans on time that show fog.




LATERAL MEDULLARY (PICA, Wallenberg) SYNDROME

Atherosclerosis of intracranial vertebral arteries* ( most severe in distal portion) often @veterbral/basilar A junction. Most often pat w proximal* paint pic of LMS

Lets review the structure involve in LMS involved
i) Nucleus & descending spinal tract of V : Sharp/jabs pain Ipsilateral FACE & EYE & numbness of face on exam you find ↓ temp & pinprick of face

ii) Vestibular nuclei/connection: Nausea/vomiting pat feel dizzy/instability on exam nystagmus with coarse rotatory eye movements ( time looking to Ipsilaterals side & small/amplitude faster nystagmus when look contralaterally)
iii) Spinothalamic tract: ↓ pinprick body & limb in CONTRALATERAL ( Note: level may be + on contralateral trunk with pain & temp loss on trunk down/lower extremity/. Pinprick & temp can extend -> contralateral face when crossed quinothalamic tract that may show medially to spinothalamic path involvement and rarely you loss of temp & pain in total contralateral & involves arm, trunk, leg and face.
iv) Inferior cerebellar peduncle: Ipsilateral limb ataxia you see your pat ( leaning/veering toward side of lesion & clumsiness ipsi limb note: on sitting or standing) on exam hpoOtonia & exaggerated rebound of same arm.
v) Nucleus ambiguus* (CN IX, X): When infarct extend medially ipsilateral paralysis of larynx, pharynx ( you notice pat keep the food w/in piriform recess and crowlike cough of pat tell you that) palate → dysarthria, dysphagia, loss of gag reflex.
vi) ANS nuclei/tracts: descending sympathic system axons traverse LM in lateral reticular formation & paralysis -> Horner. Dorsal motor nucleus CN X also can be affected -> Tachy & INC BP.
vii) Cases at times ipsi facial weakness ( ischemia of caudal part of CN VII nucleus rostral* or corticobulbar fiber going to hug CNVII .
viii) If bilateral LM lesion, then u pat gone hv hypOventilation that involve solitary/ambiguus/retroambiguus/ & parvo-giganto/CELLULARIS.
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MEDIAL MEDULLARY SYNDROME

The anterior spinal A that supply medial medulla from distal intracranial vertebral A.
i) Pic hemiparesis that affects the contralateral leg & arm ( ischemia medullary pyramid)
ii) XII nucleus/fibers: ipsilateral weakness of tongue & with deviation on protrusion to side of lesion.
iii) Medial lemniscus: with pic contralateral loss of vibration, tactile and conscious proprioception
iv) Note: In some pat you may notice intracranial vertebral A occluded & ischemia medial medulla + lateral medullary infraction => Hemimeduallry synd. Remember that has to happened at same time.
v) Rare to see bilateral medial medullary -> caudally -> rostral spinal -> synd quadriparesis & hard to dis from basilar A of pontine and I guess some had problem on my Qs on that.